Transgender Health Justice

Introduction

Yet again we have the coupling of gender identity activism coupled with HIV medicine. This time it was the turn of Dr Tonia Poteat to give a lecture on ‘Intersectional Stigma Research for Transgender Health Justice’ hosted by the Centre for Gender and Sexual Health Equity an academic research centre in British Columbia, Canada (i.e. the epicentre of trans lunacy in the entire galaxy). Dr Poteat is an American and talked about the research she was doing in North Carolina, USA and had done in South Africa in the area of HIV prevention for trans-identified males.

There were around 60 people listening in on the call, mainly professionals in the field I gathered.

A religious persuasion

Firstly I want to say that at the end of the talk she played a video called ‘Trans Agenda for Liberation‘ produced by the Transgender Law Center and Dr Poteat said she watches it because it helped her figure out what she needs to be supporting and that when she is having a bad day she plays it because it ‘makes her feel better’ and then giggled nervously.

I highly recommend watching the video, it is under one and a half minutes long. It’s pure propaganda. It mentions and features only non-white men, despite the fact that many white trans-identified females work at the Transgender Law Center, and I suspect white men and women make up the majority of the trans-identified population overall in America currently. But ‘Black trans women must be trusted to lead’ is the message.

The sloganeering at the end is positively fascistic – Trans Agenda – the call, For Liberation! – the response. The video was posted on 24 March 2020 and had had 1,200 views on the date that Poteat broadcast it to us on 19 November – so not exactly great viewing figures, but still.

The Talk

Dr Poteat began predictably enough explaining to us what ‘intersectionality’ and ‘stigma’ meant, which culminated in an ‘intersectional stigma model’, which included categories of racism, sex work stigma, homophobia and transphobia, sexism and gender discrimination, and HIV related stigma. Her intersectional stigma model therefore conveniently places black trans-identified male prostitutes at the centre of the Venn diagram model.

Structures of domination included white supremacy, cisgenderism, heteropatriarchy, capitalism, colonialism, adultism/ageism (my italics) and ableism. Institutional systems (of oppression) included everything but also notably foster care. Finally socio-structural processes included colonising, gendering, pathologising and criminalising.

HIV Work in South Africa

Dr Poteat has done HIV research in South Africa and said that the virus disproportionately affected trans-identified males. This factoid had arisen out of a project she had been involved with called Trans Women Mobilizing And Preparing for High Impact Prevent project (TMAPP) which sought to roll out the use of pre-exposure prophylaxis (PrEP) and other HIV care. The project was lead and implemented by trans-identified men, ditto all six data collectors.

HIV prevalence amongst the general population is 20.4%, but the project established rates amongst black African trans-identified males in three specific urban (possibly red light) areas showed rates anywhere between 50-73%, though Poteat admitted these were unweighted results. Factors affecting getting hold of antiretroviral therapy included not being able to get hold of transportation, negative attitudes when picking up medications and re-selling the medications. They were mainly young, black and living in poverty and 93% felt they were part of a ‘transgender community’.

Presumably at least some of the participants were in prostitution but the data presented failed to clarify this. A strange omission given the preponderance on sex work stigma and intersectionality.

‘Transgender health justice’ had been achieved by:

  • Not comparing data with that collected from studies where the term ‘men who have sex with men’ had been used (basically all other studies currently in existence).
  • Ensuring one of the principal investigators on the study was a trans-identified man.
  • Data interpretation only done by trans-identified men.
  • Interpreting the data using lens of intersectionality rather than known risk assessments like ‘risky behaviours’.
  • Fancy stats and novel measures (a data technique) not essential.

I did wonder if the money which had gone into TMAPP had been secured from funding earmarked for research for women and HIV, but she didn’t say where the funding had come from.

HIV Work in North Carolina – ‘Ending the HIV epidemic for transgender people of color’

In the US the prevalence of HIV is about 0.3% overall in the general population. First of all Dr Poteat presented statistics that trans-identified males of colour were at the highest risk of HIV infection in the transgender community, including a pointless slide comparing the statistics for trans-identified females versus trans-identified males. Again no breakdown was provided to account for sexual behaviours, nor the crucial comparison to the figures for gay and bisexual men, which as we know by now is completely forbidden.

The aim of the project was ‘not identifying risk behaviours, but addressing what barriers [there] might be’. The survey was only opened up to transgender people of colour in the first half to ensure ‘a good representation of trans people of colour’ and then it was opened up to others.

Policy analysis suggested that trans people had fewer civil rights and no hate crime legislations and there were still HIV criminalisation laws. There were no housing protections. Though the recent revision of Title VII may now make these possible.

We then suddenly lurched to the role of faith institutions and their deleterious affect on trans people. However there were also safe places that trans people could go and we were introduced to the Reverend Debra Hopkins, active in North Carolina, who is involved in various transgender organisations including Trans Faith. (Hopkins has set up a homeless/domestic violence refuge for trans people called There’s Still Hope – the website feels like an empty shell, rather than an organisation busy dealing with crises.)

Quantitative data showed that the top five priorities of the research participants were prevention of violence, affordable housing, access to cross sex hormones and surgery, health insurance to cover cross sex hormones and surgery, and making it easier to change their name and gender on documents. ‘No one selected access to HIV information and prevention services and only one person selected access to HIV treatment information and services as their top priority’. Hm.

Health worker training modules were to be developed to help manage the HIV and ‘gender-affirming’ healthcare needs in the next project. This would now be developed via an app due to COVID.

Promoting ‘transgender health justice’ in this scenario included:

  • Make visible trans agency and resilience (they consulted trans organisations).
  • Create and distribute infographics (I don’t know what this means but a nifty graphic was included on the slide with the artist’s website).
  • Open and create leadership paths for TPOC (aka jobs for the boys).

Measuring stress

Dr Poteat landed a second grant to measure the stress levels of ‘transgender women of color living with HIV’ (TWLHIV). The project was just about to launch and then the pandemic hit. Unsurprisingly her research suggests that there is a link between ‘intersectional stigma’ and ‘chronic stress’ in TWLHIV and this leads to co-morbidities. More dazzling graphs were deployed to prove link between stigma having a profound effect on the physical body and how ‘gender-affirming’ hormone therapy might fit in mitigating these effects.

The aim was to enrol around 200 black and latino trans-identified males in Washington DC and Boston. The two year study would collect salivary samples twice a day, waking and at bedtime, from the TWLHIV cohort to measure cortisol levels. Every six months additional blood work, clinical measures or qualitative interviews would be conducted to help understand their experiences of stigma and how ‘gender-affirming’ care might impact that.

The project had just started before the pandemic and had recruited 36 black males, 6 of which had to be discounted because of recent steroid use. Of the 28 remaining, 19 were on ‘gender affirming hormones’, 18 had a formal diagnosis of depression and 11 had a formal diagnosis of PTSD. Enrolment would begin again the following month.

Working to promote trans health justice in this scenario included:

  • Recruit only black and latino males and use no comparison ‘standard’.
  • Focus on stigma as the source of stress (i.e. sex work stigma, trans stigma), rather than (the more obvious) ‘essentialising inequalities’ (e.g. that they might be involved in prostitution, high risk behaviours, addicted to drugs, socially isolated).
  • Not to ask participants about their sex lives at all.
  • Identify aspects of joy and role models (nope, I haven’t a clue either).

A slide of ‘Community Partners’ was put up which included health care companies, medical universities and departments, trans organisations and naturally the South Carolina Department of Health and Environmental Control, so yet more taxpayer money.

It was just as she completed her talk that she played the awful ‘Trans Agenda for Liberation’ video that I mentioned at the beginning, and like I say it is worth watching.

My take

You don’t exactly have to work in research to see the design flaws in these projects.

With the HIV South African study, at the very least comparisons should have been made to data results for ‘men who have sex with men’ and to men and women in prostitution. The high rate of rape should have been factored in and possibly how pervasive fallacies about HIV (traditional cures for example) play into infection rates. It was a wasted opportunity to find out what is really happening with this specific demographic and to help them, because the political agenda is far more important.

As for creating a salivary cortisol study where the aim appears to be to prove that stigma is bad, and cross sex hormones are good? I can’t even. If they are all living in poverty and in sex work, they are going to be stressed, possibly being violently assaulted on a regular basis. Yet no questions about sex are to be asked, so we are never going to know, are we? Did they enter sex work because they were abused as kids? Nope, we are never going to know. How’s that for community support?

The general comments being made in chat by other professionals were all approving of Dr Poteat’s work and no difficult questions were asked. One of the participants may hold a senior teaching position in a prestigious medical school.   In fact, many commented that they wanted to include ‘intersectional stigma’ in their future research methods too.

It’s all quite mind boggling really.

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One comment

  1. Is there any other area of medicine that can get away with such poor research ? It’s no better than the research into crystals and homeopathy

    Liked by 2 people

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